Effect of Dorsal Preservation Techniques on Septum Strength: An Experimental Animal Study.

This experimental animal model study investigates the impact of different methods employed in preservation rhinoplasty (PR) on the strength of the nasal roof, focusing on three techniques: high strip, low strip, and intermediate strip. Using 15 lamb heads as surgical models, the study addresses key questions related to the strengths of each PR techniques, the influence of septal cartilage harvesting on septum strength, and the effectiveness of spreader grafts for stability. The research involves detailed dissection steps and measurements at various nasal points, evaluating the resistance at each stage. Results indicate that the low strip technique demonstrates the most significant reduction in strength. Furthermore, the combination of PR techniques with structural grafts, specifically spreader grafts, is assessed, revealing the classical rectangular spreader graft to be more effective in stabilizing the dorsum. Despite the limitation of using the lamb heads as models, this study offers valuable insights into the effects of PR on nasal septum strength and provides a foundation for further research on the biomechanics of preservation techniques.

Biomechanics of Septal L-Strut on Lamb Head Models.

It is very crucial to know the biomechanics of the septal cartilage and adjacent structures during septoplasty. The aim of this study was to investigate the strength changes of different L-strut models after mucoperichondrium elevation, application of septal extension grafts and spreader grafts on an experimental lamb model. Ten lamb heads were dissected according to a dissection protocol and septal resistances were measured with the newton meter at six zones. Three different L-strut types were designed, and all the L-strut models were created at different widths of 15mm, 10mm, and 5mm. In addition, effects of two different types of septal extension grafts and spreader grafts were compared. After mucoperichondrium elevation and harvesting the septum cartilage, there was a significant decrease in the septum resistance (p <0.05). As the width of the L-strut decreased, the septum strength decreased significantly (p <0.05). There was no significant difference between three chondrotomy types at different widths (p >0.05). There was no significant difference between the overlapping SEG and end-to-end SEG in terms of septum resistance (p >0.05). This was the first study to measure septal resistance in lamb heads. The mucoperichondrium and L-strut width were important structures for maintaining septal resistance. Chondrotomy style was not crucial, but as the width of the L-strut increased, the septal resistance increased. The septal extension grafts regardless of suturing style and the spreader grafts added strength to the caudal septum.

Endolymphatic Sac Tumor as a Ménière-Like Vertiginous Syndrome: A Case Report.

Endolymphatic sac tumors are rare benign neoplasms with locally aggressive behavior located in the posterior petrous ridge of the temporal bone. They cause sensorineural hearing loss and may develop vestibular damage. A 24-year-old male patient arrived at our office with a history of acute vertiginous syndrome, left hearing loss, and tinnitus 1-year ago. His chief complaint was an increase in auditory symptoms. A CT scan and MRI showed an endolymphatic sac tumor. Complete resection of the lesion was achieved by a transmastoid and translabyrinthine approach. Low-grade adenocarcinoma was confirmed by histopathology. The patient remained without clinical vestibular symptoms. However, a small residual tumor was addressed by gamma-ray radiosurgery. Postoperative deep left sensorineural hearing loss was identified, without any vestibular sequelae. Radiologic imaging is the most useful tool for this diagnosis. Endolymphatic sac tumors should be in the differential diagnosis of recalcitrant audio-vestibular symptoms. Complete surgical resection is the most appropriate management.

Deep Neck Infections: Demographic and Clinical Factors Associated with Poor Outcomes.

INTRODUCTION: Deep neck infections (DNIs) are abscesses located in the profound spaces of the neck and constitute one of the most common otolaryngological life-threatening emergencies. The aim of this study is to review the clinical and demographic data of patients with DNI and identify factors associated with prolonged hospitalization, reoperation, and mortality. METHODS: Retrospective review and analysis of 75 patients with DNI admitted from January 2015 to December 2019 in a tertiary referral hospital. RESULTS: Of 75 patients, 50 (66.6%) were males and 25 (33.3%) females. Age ranged from 18 to 91 years with a mean of 41.79 (±15.48). DNIs were odontogenic in 49 patients (65.3%). History of diabetes mellitus (DM) was positive in 26 patients (34.6%). The submandibular space was involved in 57 patients (76%). Streptococcus spp. were isolated in 35 patients (46%). Intubation for airway preservation was needed in 21 patients (28%) and tracheostomy in 6 (8%). Mediastinitis presented in 8 patients (10.67%), with a mortality rate of 62.5% (n = 5). Mean hospital stay was 9.13 days (±7.2). DM (p = 0.016), age (p = 0.001), BMI classification 3, 4, and 6 (p = 0.041), and intensive care unit (ICU) admission (p = 0.009) were associated with a longer stay. Surgical drainage was performed after 1.71 days (±1.65). Surgical reintervention was needed in 6 cases (8%) and was associated with temporal (p = 0.001) and masticator (p = 0.002) space involvement and DM (p = 0.009). Overall mortality was 8% and decreased to 1.5% when mediastinitis was excluded. Mediastinitis (p = 0.001), ICU admission (p < 0.0001), Streptococcus spp. (p = 0.019), and low hemoglobin levels (p = 0.004) were associated with mortality. DISCUSSION/CONCLUSION: DNIs are entities associated with high morbimortality. Mediastinitis and airway obstruction are life-threatening possible complications and should be promptly evaluated. Low HB could be used as a predicting factor for mortality.

Age adjusted normative data for Video Head Impulse Test in healthy subjects.

PURPOSE: This study aims to assess the effect of age in vestibulo-ocular reflex (VOR) gain measured by Video Head Impulse Test (VHIT) and to present normative data of VOR gain, median gain at 40, 60, 80 and 0-100 ms, and gain asymmetry according to decades of life in healthy subjects. MATERIAL AND METHODS: A total of 132 subjects with no previous history of vestibular disorders were enrolled to assess VOR gain by employing VHIT. The test was performed in the X-axis evaluating both horizontal semicircular canals (HSC). The same right-handed operator performed the test in all subjects. RESULTS: The mean VOR gain was higher in the right ear (0.99 ± 0.09) compared to the left ear (0.97 ± 0.08) (p = 0.001). Median gain at 60 ms was 0.92 ± 0.12 in the right HSC and 0.93 ± 0.10 for the left HSC, without significant difference (p = 0.94). A significant decrease of VOR gain occurred with increasing age in the right ear (r = -0.21, p = 0.01). Median gain at 60 ms decreased significantly as age increased in both HSC (right r = -0.17, p = 0.04; left r = -0.23, p = 0.006). No significant differences in VOR gain values were observed when the sample was stratified by age according to the analysis of variance. CONCLUSIONS: A slight but significant decrease in VOR function was observed as age increased for gain and median gain at 60 ms. Larger studies, including patients with central and peripheral vestibular disorders, are needed to assess the clinical implication of this effect when evaluating patients with vestibular disorders.

Sphenoid Sinus: Pneumatization and Septation Patterns in a Hispanic Population.

INTRODUCTION: Pneumatization of the sphenoid sinus (SS) varies widely among different ethnic groups. Information regarding the prevalence and significance of SS variants among Hispanic groups is limited. This study aims to describe and analyze pneumatization and septation patterns of the SS in a Hispanic population. METHODS: A total of 160 paranasal sinus computed tomographies were reviewed by a head and neck-specialized radiologist and 2 otolaryngologists. RESULTS: The postsellar and sellar types were the most frequent patterns of pneumatization observed, with a prevalence of 52.5 and 40%, respectively. Accessory septations were present in 59.4% of the patients. Septa were inserting over the internal carotid artery (ICA) in 43.8% and over the optic nerve in 17.5% of the population. No significant association (p > 0.05) was observed when comparing the different accessory septation patterns among the types of the SS. The frequency of septa inserting on the ICA was significantly higher in postsellar types (p < 0.001). Pneumatization of the anterior clinoid process, pterygoid processes, and greater wing was present in 20, 17.5, and 45.9% of the sinuses, respectively. Onodi cells were encountered in 40% of the sinuses. There were no significant differences in any of the pneumatization and septation variables when compared by gender and age (p > 0.05). DISCUSSION/CONCLUSION: Differences regarding anatomical variants and septations of the SS were observed in our study when compared with findings reported in other ethnic groups. Preoperative assessment of the anatomical variants of the SS in Mexican patients is imperative to select the most optimal surgical approach and prevent iatrogenic injuries to related neurovascular structures.